Most Dangerous Drug

[cdobe]

Chris,
I do have full access to the Journal of Neurophysiology. There's only one author by the name of John Nutt, and not David Nutt, so I'm not sure, what protocols you might have read.

You'll have to read his protocol directly. "Denying the general conclusion" is a strawman....no one has mentioned anything of the sort. As to publication, peer review doesn't occur just once and you're in the clear. Everything published in Lancet, etc. gets continually peer reviewed from the time of publication onward.

As Steve alluded to, what we call peer review in the scientific world, refers to the publishing process, when qualified referees review the paper prior to the publication of it. Criticism by readers of the journal, experts or not, is not peer review.

best

[wiesiek]

really nothing new,
alc IS most dangerous drug,
/not as exact, scale only from 1-5 ,on similar Harvard /?/study from `70 /

[Teazer]

I found David Nutt's 2007 article he has had published in the Lancet (so I didn't get the newer one, but it sounds like there's a lot of similarity in the method):
"Development of a rational scale to assess the harm of drugs of potential misuse" Lancet 2007; 369: 1047–53
It is only 7 pages long and a very straight-forward study to boot. For the sake of discussion, I've outlined details of the study below.

In it he uses 3 categories of harm: "the physical harm to the individual user caused by the drug;the tendency of the drug to induce dependence; and the effect of drug use on families, communities, and society"
Within physical harm, he introduces scores for chronic use as well as acute short term risks. The rating of drugs comes from "delphic analysis" - i.e. using a panel of experts to rate their level of harm for each of 3 subset variables from the 3 categories of harm (as listed below) with a 4 point scale. He gets ratings for each variable by a group of 29 psychiatrists as well as members of the panel of the Independent Inquiry into the Misuse of Drugs Act. (results of the two groups were consistent).
Physical harm: Acute, Chronic, Intravenous harm
Dependence: Intensity of pleasure, Psychological dependence, Physical dependence
Social harms: Intoxication, Other social harms, Health-care costs

As far as statistical method, for the overall harm rating of each drug he just took the mean of these scores. While the paper didn't include an analysis based on score variance (which I think would be important to know), the risk score for alcohol was higher than cannabis for all variables. He also mentions the scores were consistent amongst the different experts. Other issues involve the potential overlap of some of the measures, as well as the equal weighting which deserves some robustness checks. As a method, using such a survey has some potential flaws since actual data of harm is introduced indirectly by the experts, though that can be a benefit too. Consequently, I would say only particularly obvious results should be used for policy decisions. For instance, there's an argument for weighting the social harms higher and leaving the individual risk assessment and choice to the individual. It does, however rate as a better determinant of drug risk (and government policy) than the current method (which has no obvious standards).

[Teazer]

aha here's the new one:
The Lancet, Volume 376, Issue 9752, Pages 1558 - 1565, 6 November 2010
The only difference is now it's 8 pages long and the panel of experts was "Members of the Independent Scientifi c Committee on Drugs, including two invited specialists", and a more precise set of variables. Looking at the new list (which I've added below), there are even greater issues regarding weighting these, particularly combined with a scale for each going from 0-100 making it even more crucial that he use some kind of significance tests or methods to reduce the effects of outliers.

The variables were:
Drug-specific mortality: Intrinsic lethality of the drug expressed as ratio of lethal dose and standard dose (for adults)
Drug-related mortality: The extent to which life is shortened by the use of the drug(excludes drug-specifi c mortality)—eg, road traffi c accidents,lung cancers, HIV, suicide
Drug-specifi c damage: Drug-specifi c damage to physical health—eg, cirrhosis, seizures, strokes, cardiomyopathy, stomach ulcers
Drug-related damage: Drug-related damage to physical health, including consequences of, for example, sexual unwanted activities and self-harm, blood-borne viruses, emphysema, and damage from cutting agents
Dependence: The extent to which a drug creates a propensity or urge to continue to use despite adverse consequences (ICD 10 or DSM IV)
Drug-specifi c impairment of mental functioning: Drug-specifi c impairment of mental functioning—eg, amfetamine-induced psychosis, ketamine intoxication
Drug-related impairment of mental functioning:—eg, mood disorders secondary to drug-user’s lifestyle or drug use
Loss of tangibles:Extent of loss of tangible things (eg, income, housing, job,educational achievements, criminal record, imprisonment)
Loss of relationships: Extent of loss of relationship with family and friends
Injury: Extent to which the use of a drug increases the chance of injuries to others both directly and indirectly—eg, violence (including domestic violence), traffi c accident, fetal harm,drug waste, secondary transmission of blood-borne viruses
Crime: Extent to which the use of a drug involves or leads to an increase in volume of acquisitive crime (beyond the use-ofdrug act) directly or indirectly (at the population level, not the individual level)
Environmental damage: Extent to which the use and production of a drug causes environmental damage locally—eg, toxic waste from amfetamine factories, discarded needles
Family adversities: Extent to which the use of a drug causes family adversities— eg, family breakdown, economic wellbeing, emotional wellbeing, future prospects of children, child neglect
International damage :Extent to which the use of a drug in the UK contributes to damage internationally—eg, deforestation, destabilisation of countries, international crime, new markets
Economic cost: Extent to which the use of a drug causes direct costs to the country (eg, health care, police, prisons, social services, customs, insurance, crime) and indirect costs (eg, loss of productivity, absenteeism)
Community:Extent to which the use of a drug creates decline in social cohesion and decline in the reputation of the community

[Steve James]

As a method, using such a survey has some potential flaws since actual data of harm is introduced indirectly by the experts,

Well, it was a survey of experts, not an experiment on or a survey of subjects. (Getting all the heads together to determine harm wouldn't be considered valid methodology. Rastas will tell you that it's the best thing in the world. It'd be a little like asking alcoholics --or AA members-- for their opinions).

It does, however rate as a better determinant of drug risk (and government policy) than the current method (which has no obvious standards).

I would say the standards are obvious, but based on moral perspectives, not on the harm or risk to individuals or the comparative (harmful) effects of specific drugs. Fundamentally, it is merely the demand for an answer to the question/s "Why" people go to jail for ingesting certain substance (into their own bodies. Second hand tobacco smoke is another important question when it comes to making judgments on these issues).

Anyway, I wasn't interested in making a judgment. I'm against legalizing drugs. I just think it's poor policy to criminalize them. It's expensive and generally counter-productive. If there's money to be spent (by society), it should be spent on the most severe problem. We don't treat alcohol drinkers or alcoholics, smokers or cigarette addicts as criminals.

[Darth Rock&Roll]

This just in..."Duh"
Pictures at 11:00

[Darthwing Teorist]

I don't know if they considered that alcohol is more widespread than any other drug. If aspirine was the most widespred drug, I am sure that it would rate higher than any other too because the effects are on another order of magnitude.

The effects of the drug and it's spread of usage are two different things when arriving at such general conclusions.

[Steve James]

I don't know if they considered that alcohol is more widespread than any other drug.

They did, in fact it's part of the rationale for considering it "more" dangerous (because it will obviously have a greater negative effect because of its obviously greater distribution). However, greater distribution and availability would do nothing to suggest that alcohol is "less" dangerous that a less available drug. THAT, imo, is the only relevant counter-argument: i.e., just show --using similar methods-- that "drug X" is more damaging/harmful/dangerous (for an individual and/or society) that alcohol.

Hey, I drink alcohol, and I don't do heroin. For me, heroin is more dangerous for me. Otoh, if I counted the number of people who've died from heroin addiction and compared it to the number who've died from alcohol, the result would be a number. I could, on the contrary, look at the results of people who've only tried alcohol or heroin and compare that with different results.

If there are no reported cases of deaths from a drug, then it's not necessary to do testing (imo) to show that it is less dangerous than a drug that has caused hundreds of thousands of deaths, and is considered by law enforcement to be involved in a high percentage of crime.